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Guides you through treatment choices for lumbar spinal stenosis. Covers tests used to diagnose and guide treatment. Discusses treatment with medicines, lifestyle changes, physical therapy, or surgery. Includes interactive tool to help you make your decision.

Lumbar Spinal Stenosis: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Lumbar spinal stenosis is the
narrowing of the spinal canal in the low back (lumbar). This usually occurs when bone and other tissues grow
inside the openings in the spinal bones. This can squeeze the nerves that
branch out from the spinal cord. The
squeezing can cause pain, numbness, or weakness, most often in the legs, feet,
or buttocks.

The
purpose of surgery to treat spinal stenosis is to relieve pressure on the spinal nerve roots. The main type of surgery for spinal stenosis
is decompressive laminectomy. It removes
bone (parts of the vertebrae) and/or thickened tissue that is narrowing the
spinal canal and squeezing the spinal nerves.

In some
cases,
spinal fusion may be done at the same time. This
surgery joins, or fuses, two or more bones so that the joints can no longer
move.

Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.1

By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.1 This difference continues for at least 4 years after surgery.2

The benefits of surgery appear to last for many years. After 8 to 10
years:

People treated with surgery were as
satisfied as those treated without surgery.

People who had surgery
were generally able to be more active and had less leg pain than those who had
nonsurgical treatment.3

Surgery appears to be more effective for leg pain than for back pain, but it may help both.4

If you have mild or moderate symptoms, there
is very little or no risk in not having surgery. Your symptoms can most likely
be relieved with nonsurgical treatment.

Experts agree that the
course of spinal stenosis varies—it may stay the same, get better, or get
worse. But if symptoms are very painful or uncomfortable, they usually don't
improve on their own. If you have very bad symptoms, not having surgery means
that your normal daily activities may be limited and you will have to live with
the pain and discomfort.

Personal stories about having surgery for spinal stenosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

The pain and
numbness in my legs got to the point where I could hardly walk. After my MRI
showed I had spinal stenosis, my doctor said that the final decision for
treatment was up to me—I should consider how bad the pain is and whether I can
do my normal daily activities. Since I could hardly do my simple everyday
routines without pain, I figured that it was time for surgery.

Ed, age
62

I have been working with a physical therapist for several months now to relieve my leg pain that is caused by
spinal stenosis. My doctor says surgery may be an option if my leg pain gets
worse, but I want to wait and see if other steps help relieve the pain first.
The physical therapy seems to be working, so I will stick with it for now.

Tom, age
52

I noticed the numbness and pain in my legs
for a while. It came on gradually, and I could manage it with pain relievers.
Over time, though, the symptoms got worse and worse. Eventually, the pain got
so bad that walking was quite uncomfortable. Since I don't have any other major
health problems, I decided to have surgery so I wouldn't have to deal with the
leg pain and could start walking again!

Clare, age 70

The pain,
numbness, and tingling in my legs started about 5 years ago. Luckily, I did not
feel pain all of the time when I was walking. When I was diagnosed with spinal
stenosis, my doctor said that there were several things I could do to keep my
pain at a minimum, such as using pain relievers, exercising, and keeping my
weight down. That's what I'm doing, and now I hardly ever get leg pain and am
relieved that I avoided surgery.

Susan, age 64

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for lumbar spinal stenosis

Reasons not to have surgery

I want surgery if there is a chance it will help me.

I want to avoid surgery at all costs.

More important

Equally important

More important

My work and home life are flexible enough that I can take the time I need to recover after surgery.

I can't afford to take time off.

More important

Equally important

More important

Nonsurgical treatments have not worked well enough for me.

I want to keep trying nonsurgical treatments and see if they help me feel and move better.

More important

Equally important

More important

Getting relief from my pain and weakness will be worth it, even if I need to have the surgery again in a few years.

I'm not sure it's worth it to have surgery that might need to be repeated in a few years.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

If your symptoms aren't very bad, should surgery be your first choice of treatment?

YesNo, that's not right. If your symptoms are mild to moderate, then medicine, physical therapy, and exercise may be all you need.

NoThat's correct. If your symptoms are mild to moderate, then medicine, physical therapy, and exercise may be all you need.

I'm not sureIt may help to go back and read "What nonsurgical treatments are used for spinal stenosis?" If your symptoms are mild to moderate, then medicine, physical therapy, and exercise may be all you need.

2.

Will surgery help your leg pain?

YesThat's right. Surgery can help leg pain. It may relieve back pain too, but it usually relieves leg pain more.

NoSorry, that's wrong. Surgery can help leg pain. It may relieve back pain too, but it usually relieves leg pain more.

I'm not sureIt may help to go back and read "How well does surgery work?" Although surgery may help leg and back pain, it usually relieves leg pain better than back pain.

3.

If you have surgery, will the results last for a long time?

YesThat's correct. When surgery helps relieve symptoms, the results appear to last for several years.

NoNo, that's not right. When surgery helps relieve symptoms, the results appear to last for several years.

I'm not sureIt may help to go back and read "How well does surgery work?" When surgery helps relieve symptoms, the results appear to last for several years.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Lumbar Spinal Stenosis: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

1. Get the Facts

Your options

Key points to remember

If your symptoms from
lumbar (low back) spinal stenosis are mild to moderate, then medicine,
physical therapy, and exercise may be all you need.

You may want
surgery if you have tried other treatment for a while and your pain is still so
bad that you can't do your normal activities.

Your symptoms may come back a few years
after surgery, and you may need surgery again.

Surgery will
probably help leg pain. But it may not help back pain as much.

FAQs

What is lumbar spinal stenosis?

Lumbar spinal stenosis is the
narrowing of the spinal canal in the low back (lumbar). This usually occurs when bone and other tissues grow
inside the openings in the spinal bones. This can squeeze the nerves that
branch out from the spinal cord. The
squeezing can cause pain, numbness, or weakness, most often in the legs, feet,
or buttocks.

Symptoms may be very bad at times and not so bad at
other times.

What tests may help in choosing treatment?

Before
you decide about surgery, you may need to have an
X-ray, an
MRI, or a
CT scan. These imaging tests can find any narrowing of
your spinal canal and the exact location of any problems.

In
addition to the imaging test results, you need to consider how severe your
symptoms are and how they affect your quality of life.

What nonsurgical treatments are used for spinal stenosis?

If your symptoms are mild or moderate, they can most
likely be relieved with nonsurgical treatment. This includes:

Medicines.
Acetaminophen, such as Tylenol, and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve) may help your pain.

Healthy body weight. Getting to and staying at a healthy body
weight may help your symptoms and keep the stenosis from getting worse.

Physical therapy. This helps
you learn stretching and strength exercises that may reduce pain and other
symptoms.

Steroid injections. These are
shots that may help relieve pain if other nonsurgical treatments haven't
worked.

What is the surgery for lumbar spinal stenosis?

The
purpose of surgery to treat spinal stenosis is to relieve pressure on the spinal nerve roots. The main type of surgery for spinal stenosis
is decompressive laminectomy. It removes
bone (parts of the vertebrae) and/or thickened tissue that is narrowing the
spinal canal and squeezing the spinal nerves.

In some
cases,
spinal fusion may be done at the same time. This
surgery joins, or fuses, two or more bones so that the joints can no longer
move.

How well does surgery work?

Research shows
that:

Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.1

By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.1 This difference continues for at least 4 years after surgery.2

The benefits of surgery appear to last for many years. After 8 to 10
years:

People treated with surgery were as
satisfied as those treated without surgery.

People who had surgery
were generally able to be more active and had less leg pain than those who had
nonsurgical treatment.3

Surgery appears to be more effective for leg pain than for back pain, but it may help both.4

What are the risks of surgery for lumbar spinal stenosis?

Surgery may not be an option if you have other serious health problems
that make surgery too risky.

All surgery has risks. These risks
may be more serious for an older adult. Possible problems from surgery
include:

Tears in the fibrous tissue that
covers the spinal cord and the nerve near the spinal cord, sometimes requiring
more surgery.

Trouble passing urine, or loss of bladder or bowel
control.

Long-term (chronic) pain, which develops after surgery in
some cases.

Death from problems caused by surgery, but this is rare.

Symptoms may return after a few years. Some people have
repeat surgery.

What are the risks of not having surgery
for lumbar spinal stenosis?

If you have mild or moderate symptoms, there
is very little or no risk in not having surgery. Your symptoms can most likely
be relieved with nonsurgical treatment.

Experts agree that the
course of spinal stenosis varies—it may stay the same, get better, or get
worse. But if symptoms are very painful or uncomfortable, they usually don't
improve on their own. If you have very bad symptoms, not having surgery means
that your normal daily activities may be limited and you will have to live with
the pain and discomfort.

Why might your doctor recommend surgery for lumbar spinal stenosis?

Your doctor might recommend surgery if:

Your pain and weakness are bad enough to get
in the way of your normal activities and have become more than you can
manage.

You've tried other treatments—medicine, exercise, physical
therapy—for at least a few months and they haven't worked.

You are
less able to control your bladder or bowels than usual.

You notice
sudden changes in your ability to walk in a steady way, or your movement
becomes clumsy.

2. Compare your options

Have surgery

Don't have surgery

What is usually involved?

You are asleep during the
operation.

You stay in the hospital for a few days.

It can take
up to several months before you return to your normal activities.

You can try other treatments
to help your symptoms, including medicine, exercise, and physical therapy.

What are the benefits?

Most people who have surgery are
satisfied with the results.

Surgery can relieve pain and improve walking ability.

Nonsurgical treatments
usually work well for people with mild to moderate symptoms.

You
avoid the risks of surgery.

What are the risks and side effects?

All surgery has some
risks, including bleeding, infection, and risks from
anesthesia.

You may not be able to return to all of your normal
activities for at least several months.

Your symptoms may come back
in a few years, and you may need surgery again.

Your symptoms
may continue to bother you.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about having surgery for spinal stenosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"The pain and numbness in my legs got to the point where I could hardly walk. After my MRI showed I had spinal stenosis, my doctor said that the final decision for treatment was up to me—I should consider how bad the pain is and whether I can do my normal daily activities. Since I could hardly do my simple everyday routines without pain, I figured that it was time for surgery."

— Ed, age
62

"I have been working with a physical therapist for several months now to relieve my leg pain that is caused by spinal stenosis. My doctor says surgery may be an option if my leg pain gets worse, but I want to wait and see if other steps help relieve the pain first. The physical therapy seems to be working, so I will stick with it for now."

— Tom, age
52

"I noticed the numbness and pain in my legs for a while. It came on gradually, and I could manage it with pain relievers. Over time, though, the symptoms got worse and worse. Eventually, the pain got so bad that walking was quite uncomfortable. Since I don't have any other major health problems, I decided to have surgery so I wouldn't have to deal with the leg pain and could start walking again!"

— Clare, age 70

"The pain, numbness, and tingling in my legs started about 5 years ago. Luckily, I did not feel pain all of the time when I was walking. When I was diagnosed with spinal stenosis, my doctor said that there were several things I could do to keep my pain at a minimum, such as using pain relievers, exercising, and keeping my weight down. That's what I'm doing, and now I hardly ever get leg pain and am relieved that I avoided surgery."

— Susan, age 64

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for lumbar spinal stenosis

Reasons not to have surgery

I want surgery if there is a chance it will help me.

I want to avoid surgery at all costs.

More important

Equally important

More important

My work and home life are flexible enough that I can take the time I need to recover after surgery.

I can't afford to take time off.

More important

Equally important

More important

Nonsurgical treatments have not worked well enough for me.

I want to keep trying nonsurgical treatments and see if they help me feel and move better.

More important

Equally important

More important

Getting relief from my pain and weakness will be worth it, even if I need to have the surgery again in a few years.

I'm not sure it's worth it to have surgery that might need to be repeated in a few years.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
If your symptoms aren't very bad, should surgery be your first choice of treatment?

Yes

No

I'm not sure

That's correct. If your symptoms are mild to moderate, then medicine, physical therapy, and exercise may be all you need.

2.
Will surgery help your leg pain?

Yes

No

I'm not sure

That's right. Surgery can help leg pain. It may relieve back pain too, but it usually relieves leg pain more.

3.
If you have surgery, will the results last for a long time?

Yes

No

I'm not sure

That's correct. When surgery helps relieve symptoms, the results appear to last for several years.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

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How this information was developed to help you make better health decisions.